Originally published 5/14/2020
The blog we posted nearly 4 years ago (below) emphasizes the importance of 5 easy-to-remember, all natural steps to men’s wellness.
At our Center, we believe in the power of lifestyle changes to promote robust long life for aging men. However, we also recognize that aging generally leads to lower testosterone levels.
If low T impacts a man’s well-being and vigor, testosterone replacement therapy (TRT) can boost wellness during aging. It improves “overall sexual activity, sexual desire, and erectile function; improves areal and volumetric bone density, as well as estimated bone strength in the spine and the hip; corrects unexplained anemia of aging; increases skeletal muscle mass, strength and power, self-reported mobility, and some measures of physical function; and modestly improves depressive symptoms.”[i]
There’s a catch, though. The Endocrine Society discourages use of TRT based only on symptoms. Instead, it recommends a thorough diagnostic work-up (proper blood tests, ruling out other causes) to determine if TRT is needed to supplement healthy lifestyle habits.
“In the future aging society, more attention should be paid to the importance of men’s health because of its effects on decreased quality of life and increased social burden…” Park & Lee
Let’s face it, guys. We’re not getting any younger. In fact, society is getting older. The Population Reference Bureau tells us that in the U.S, the number of those age 65 and up is expected to nearly double from 52 million in 2018 to 95 million by 2060, and this age group will expand from 16% of the total population to 23%–nearly a fourth![ii]
Since men generally have higher death rates (at every age, not just advanced years), the older we get the more women there are than men. For example, here’s a 1994 statistical projection: in 1994, elderly women outnumbered men by 3 to 2, but the gap widened as age increased; at ages 65-69 it was 5 men for every 6 women, but by age 85 and up, it was 2 men for every 5 women. So not only are we not getting younger, but as we grow old, we make up less and less of the aging population.
The gap between women’s health and men’s health
There are many reasons and theories for why women outlive us men. Some factors may be related to biological differences, some to environmental causes such as exposure to industrial toxins, some to social factors such as risk-taking behaviors or macho expectations that generate chronic stress leading to cardiovascular problems, metabolic syndrome, etc.
There is also a gap between the ways that women organize themselves around awareness of health issues and generate demand for health services vs. the ways that men tend not to talk about their physical, mental and emotional wellness as well as put off doctor visits.
One hypothesis for the relative lack of men’s health awareness as we age is that women go through a dramatic hormonal drop over a relatively brief span of years i.e. menopause, while men go through a relatively long drawn out aging-related decrease in testosterone. In other words, it’s easier to define the health issues of aging women than it is to pinpoint those of men—and yet, gender-related hormonal changes can significantly impact both a person’s physiology and their will to do anything about it in terms of lifestyle changes.
Changing the medical model for aging men
All of this was concerning enough for two Korean physicians to publish their observations. Drs. Byoungiin Park and Yong Jae Lee make a strong argument for shifting the focus away from disease events and related disabilities to lifestyle modifications that men can achieve to preventing disease and managing risk factors in order to slow the aging-related “progression of morbidities with related quality of life issues.”[iii]
Park and Lee are by no means the first to propose a reformation of our medical model more in the direction of prevention and holistic well-being. In such a model, the role of physicians would be not only to treat disease or injury, but to advise and coach their male patients on what it is that shortens their lives compared to women, and encourage healthy practices in daily life.
Specifically, they offer five healthy changes labeled “A, B, C, D, E” according to their names, for easy memory:
- Avoid the smoking habit and moderate alcohol consumption
- Body weight, with waist circumference management
- Control blood pressure, glucose and cholesterol and maintain cognitive health
- Do regular exercise and keep physically active
- Emotional health maintenance, including stress management and good sleep
I periodically address these wellness ways of life in separate blogs, but I admire how much terrific advice they have compressed into their A, B, C, D and E of men’s health. Sure, we’ve all heard this information umpteen times, but often in piecemeal fashion. There it is, everything a man needs to age well and long!
In addition to boosting each man’s personal well-being, the Park & Lee system would lower the cost to society. Just as the population numbers add up to millions of increasingly elderly members of society, the money spent out-of-pocket, by private insurance, and by public welfare increases exponentially. The National Bureau of Economic Research reports, “Medical spending by the elderly is highly concentrated. Individuals in the top 5 percent of the distribution of total expenditures spend about $98,000 per year, nearly seven times the overall average of $14,000 and accounting for 35 percent of all medical spending.”[iv] Thus, an aging man who commits himself to healthy habits isn’t just doing himself a favor. To everyone’s benefit, he is likely to incur fewer medical expenses than a same-age buddy who is living with diabetes and high blood pressure.
Park & Lee’s 2020 publication of their “Five Easy Pieces” of the health puzzle offers men, an easy-to-remember pathway to personal total health, and a way to keep our numbers as strong as women’s.
NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.
References
[i] Rodrigues Dos Santos M, Bhasin S. Benefits and Risks of Testosterone Treatment in Men with Age-Related Decline
in Testosterone. Annu Rev Med. 2021 Jan 27;72:75-91.
[ii] https://www.prb.org/aging-unitedstates-fact-sheet/
[iii] Park B, Lee YJ. Upcoming Aging Society and Men’s Health: Focus on Clinical Implications of Exercise and Lifestyle Modification. World J Mens Health. 2020;38(1):24?31.
[iv] https://www.nber.org/aginghealth/2015no2/w21270.html
About Dr. Dan Sperling
Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.
